Tinnitus affects millions of people in the United States, and it may be very painful. Tinnitus is the sense of sound when no actual external noise is present.

Tinnitus is commonly described as “ringing in the ears,” although it can also be heard as buzzing, hissing, whistling, swooshing, and clicking. Tinnitus can be a transient or brief condition, or it can be a chronic, long-term issue.

Aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), and acetaminophen are examples of over-the-counter (OTC) analgesics that are widely available without a prescription and widely regarded to be safe.

However, excessive use, such as accidentally exceeding a prescribed dose when taking cold and sinus drugs that contain these analgesics, can be harmful.

Although extremely high doses of aspirin can cause reversible tinnitus, a new longitudinal study led by investigators at Brigham and Women’s Hospital examined whether frequent use of typical doses of common analgesics, such as low- and moderate-dose aspirin, NSAIDs, and acetaminophen, or prescription COX-2 inhibitors, is independently associated with the risk of developing chronic persistent tinnitus.

The researchers write in the Journal of General Internal Medicine that frequent use of NSAIDs or acetaminophen, as well as regular use of COX-2 inhibitors, was associated with an increased risk of tinnitus.

Low-dose aspirin usage was not linked to an increased risk of persistent tinnitus, whereas moderate-dose aspirin use was linked to a higher risk of persistent tinnitus in women under 60.

“Even though these analgesics are widely available without a prescription, these are still medications, and there are potential side effects,” says lead author Sharon Curhan, adding “our findings suggest that analgesic users may be at higher risk for developing tinnitus and may provide insight into the precipitants of this challenging disorder.”

Curhan and colleagues studied 69,455 women who took part in the Nurses’ Health Study II (NHSII) as part of the Conservation of Hearing Study (CHEARS). At the time of registration, the women were between the ages of 31 and 48, and they were followed for almost 20 years. The primary outcome investigated was incident (new onset) persistent tinnitus, which was defined as tinnitus experienced by the subject for more than a week. Alternative definitions of tinnitus, such as persistent tinnitus lasting 5 minutes or longer and tinnitus that occurs every day, were also investigated. Participants were asked about their usage of over-the-counter pain relievers as well as COX-2 inhibitors, a prescription NSAID having similar qualities to other NSAIDS but fewer gastrointestinal side effects (before to the onset of tinnitus).

They discovered:

• Moderate-dose aspirin use on a weekly basis (6 to 7 days) was linked to a 16 percent increased incidence of tinnitus in women under 60, but not in women over 60.
• The use of low-dose aspirin (less than 100 mg) on a regular basis was not linked to an increased risk of acquiring tinnitus.
• Frequent use of NSAIDs or acetaminophen was linked to a nearly 20% increased risk of having tinnitus, with the magnitudes of the increased risks increasing with the frequency of use.
• The use of COX-2 inhibitors on a regular basis (two or more days per week) was linked to a 20% increased chance of acquiring tinnitus.

The article notes that subjects self-reported tinnitus and analgesic use. Subjective tinnitus can only be detected by the person experiencing it, hence research relied on self-reporting. The study’s observational approach prevented them from assigning causality. Because the study population was mostly white and all of the participants were women, more research on non-white groups and men is needed.

“Based on these findings, it will be informative to examine whether avoidance of analgesics may help alleviate tinnitus symptoms,” adds Curhan. “OTC analgesics clearly have benefits with short-term use. However, frequent use of these medications and use over long periods of time may increase the risk of tinnitus and may cause other adverse health effects. Therefore, it is important to take these medications mindfully and to limit their use as much as possible, and to discuss any change in medication use, whether prescription or non-prescription, with your health-care provider.”

Source: 10.1007/s11606-021-07349-5

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